December 2015

2018 MIDTERM ELECTION

One other small Medicaid expansion entry: Alaska, which just formally launched the expansion program on September 1st, has enrolled about 7,700 residents to date. While that's a pretty tiny number, Alaska only has about 740,000 residents total, of which only 42,000 are even eligible for ACA expansion anyway:

JUNEAU, Alaska (AP) — About 7,700 people have enrolled in Medicaid since the state expanded the program on Sept. 1 to cover more lower-income Alaskans, a state health department official said.

The agency appears on track with projections that a total of about 20,100 newly eligible people would enroll in Medicaid during the first year of expansion, Chris Ashenbrenner, Medicaid program coordinator for the health department, said Tuesday.

A study commissioned by the department estimated that about 42,000 people would be eligible for Medicaid under expansion but only about 20,100 would enroll the first year.

In October, however, things picked up; while not nearly the half-million-plus-per-month that we saw during 2014 and the first half of this year as the bulk of ACA Medicaid expansion went into effect in most states, the total number of people enrolled in the program did still increase by a respectable 187,958 people month over month.

This has resulted in a net enrollment increase of over 13.5 million people since the ACA expansion program went into effect two years ago, and a grand total of 71.8 million enrolled in the program nationally.

Back on December 17, I noted that the Maryland ACA exchange had managed (with the help of automatic renewals) to achieve just under 150,000 QHP selections as of 12/15...which happened to be both their and my projected target for the full 2016 Open Enrollment Period. This was excellent for two reasons: They had effectively hit the target (well, 149,765, anyway)...and had done so with nearly 7 weeks to go.

1) More than 382,000 Marylanders have gotten coverage since Open Enrollment started.

As of Dec. 28, 362,520 Marylanders enrolled in health coverage for 2016, including 71,055 Marylanders who chose a new Qualified Health Plan, and 79,238 people already enrolled who renewed their plan for next year. This also includes 212,227 Marylanders who enrolled in Medicaid coverage through the state marketplace since Nov. 1.

As expected, Week Eight was extremely quiet; not only did the entire week take place after the (extended) deadline for January coverage, but there was also Christmas Eve and Christmas Day to contend with. Needless to say, very few people feel like enrolling in healthcare coverage on December 24th or 25th.

Last year, just 96,000 people chose to do so between 12/20 - 12/26 in the 37 states covered by HC.gov. I was expecting slightly more this year (100K even), but only 74,000 did...26% fewer than the same week in 2014. Whatever else is going on, it's safe to say that the Open Enrollment Periods are starting to become more and more "front-loaded".

I launched the "State by State" chart feature towards the end of the 2015 Open Enrollment period last time around, and it proved to be pretty popular, so I've brought it back this year.

It's important to note that I'm still missing data from some state exchanges; I have bupkis from DC, Kentucky, New York or Vermont. I also only have partial data from others (California includes new enrollees only, while several other states only have data for the first couple of weeks).

With all those caveats out of the way, here's where things stand. Just like last year:

When ass-half Matt Bevin was running for Kentucky Governor, he campaigned explicitly on wiping out the state's expansion of Medicaid to over 400,000 Kentuckians under the Affordable Care Act.

As election day actually approached, he began kind of, sort of walking this pledge back, making vague references to possibly shifting to some form of "waiver" version of Medicaid expansion, along the lines of several other states. These vary from fairly mild (small co-pays/nominal premium payments, as we have here in Michigan) to extremely confusing/complicated, as they have in Indiana:

As I noted last Tuesday, the Week Seven HC.gov Snapshot Report threw a bit of a curveball; while they did add most of the bulk auto-renewals to the total, they also stated that some unknown number had yet to be added. As far as I can tell, that number could be as low as 1...or (theoretically) as high as 680,000. My best spitball take is that it was somewhere around 150,000, which presumably have all been added to this week's report.

As for new enrollments, with Week Eight taking place a) entirely after even the extended deadline for January coverage and b) the same week as Christmas Eve and Day, I'm not expecting many to be added; perhaps 100,000 or so, for a grand total of roughly 250,000 for the week, which in turn would bring the cumulative total (for the federal exchange only) up to right around 8.50 million even.

NYC man sues health care provider Fidelis Care, says Obamacare gave him few options and insurer's site was 'plagued with errors'

Hmmm...OK, he's suing a private insurance corporation, saying that the private insurance corporation's website was error-plagued. So what part does the ACA play in this?

Trying to find a gynecologist for his wife on a New York state health care exchange gave a Manhattan lawyer a major headache.

In papers filed in Manhattan Supreme Court, Robert Neal Halpern says he and his wife were automatically enrolled in Fidelis Care after their previous Affordable Health Care Act insurer, Official Health Plan Marketplace, went belly-up in November.

Every time Covered California issues a press release, it's like Lucy pulling away the football from Charlie Brown; I always think that this time they're gonna finally let me know how many current ACA exchange enrollees have re-enrolled for 2016...but it never has that number included. Considering that it could potentially be as high as 1.3 million people, that's kind of a big deal (although I realistically expect the number to be somewhere between 1.0 - 1.2 million at most).

Now that we're past the official (and extended) deadlines for January coverage in most states, I no longer have to add the auto-renewal caveat for states which "pre-loaded" them such as Rhode Island, Connecticut and Massachusetts. Having said that, Rhode Island, which already had one of the later deadlines in the first place, just bumped it out even later...all the way out through tonight (12/29).

Having such a small population, Rhode Island's latest update doesn't have much impact nationally, but it's still worth noting the weekly trend (remember, today's update still doesn't include the final 3 days of their extended deadline):

Some insurers said they were doing fine, and the biggest insurers reported solid 2014 profits.

...Mark Farrah Associates (MFA) has now published a review of 2014 medical loss ratio (MLR) data that implies that carriers in some states might have done a good job of setting premiums at a high enough level to generate underwriting gains.

Regular site visitors know that I spent several months last fall poring over various insurance carrier rate filings in order to patch together, as best as I could, a rough idea of the weighted average premium rate increases for each state (and nationally) based on the average rate hikes by individual carriers, weighted by their market share by effectuated enrollees.

This project was helped to some degree by the introduction of the HealthCare.Gov Rate Review Database, where you can easily search for different carriers by state/other criteria and find out what their average rate hikes (proposed and, later on, approved) will be for 2016.

Last week I asked "How many HC.gov auto-renewals are left to be added?" I noted that 5.86 million current exchange enrollees have been confirmed to have been renewed/re-enrolled via the federal exchange (71% of 8.25 million total), and that there could theoretically be up to 680K left to be auto-renewed, assuming that the currently-effectuated number is indeed still 9.1 million nationally:

The 9/30/15 number isn't what's relevant here; what we need to know is the December number. For that, HHS is still quite insistent that it'll end up being 9.1 million. While I was more optimistic earlier this year (I assumed it'd still be close to 9.7 million nationally as of now), it's pretty obvious that the attrition rate has indeed been higher than I figured, so I'll go with their 9.1 million.

If so, and assuming the federal-to-SBM ratio has remained the same, that suggests that as of December, HC.gov states are down to 6.54 million people as of today.

I finally found time to take my wife and son to see "Star Wars: The Force Awakens" over the weekend. It wasn't perfect, of course, but it was still amazingly good; easily better than the Godawful Prequels, and somewhat better than Return of the Jedi. I'd call it on par with the original (nothing can match Empire Strikes Back, of course).

Anyway, I've seen lamentations from a few people who are under the impression that they're "the only one" who hasn't seen it yet. However, aside from the simple fact that more than one person stating this means, by definition, that they're not the only one, perhaps this will make those folks feel better:

While the number of auto-renewals ended up being a bit lower than I expected, they still brought the 2016 same-point comparison up from Gottlieb's claim of 36% behind 2015 to 25% ahead...with an unknown additional number of auto-renewals (I'm guessing around 150K) yet to be added over the next week or so.

I ran a version of this last year, and the response was positive enough that I've decided to do it again for the third year of open enrollment. Anyone who's into data visualization should find this pretty interesting.

What I've done here is to take the 2014, 2015and2016 ACA Exchange Open Enrollment Period graphs and lay them on top of each other. It's important to keep in mind that these are for the open enrollment periods only.

Since 2014's period was 197 days (182 official, plus a 15 day "overtime" period), I've scaled it down to match 2015's 100 day period (93 days + 7 day overtime period) and 2016's 92 day period (I'm assuming there won't be any "overtime" this year, but could be wrong).

On the one hand, the total numbers to date sound pretty impressive, and over 20 states are running well ahead of my projections so far (Massachusetts & Maryland have already hit my targets; SD, UT, RI, MT & TN are close behind). On the other hand, I'm also starting to see some worrying signs in a few large states, particularly Texas, Illinois, New Jersey and Pennsylvania.

Here's an irony for you: Take a look at what the state-by-state chart looks like when you divide it into the states which are currently above where I expected them to be right now and those which are behind (remember, 5 states aren't listed at all, since they haven't provided any data at all or only very limited in the case of California):

Since Open Enrollment began on November 1, millions of Americans have learned about the financial help available and selected quality plans through the Marketplace for 2016. While six weeks remain before the final deadline, early consumer behavior and enrollment trends are beginning to surface. The following charts provide a preliminary analysis of plan selections ahead of the deadline for January 1 coverage through the HealthCare.gov platform.

The Washington Health Benefit Exchange is alerting residents today that only a few hours remain to sign up for health coverage throughwahealthplanfinder.org that goes into effect on Jan. 1. Customers have until tomorrow, Dec. 23 to select a Qualified Health Plan that begins at the start of the New Year.

While the deadline for Jan. 1 coverage extends to 11:59 p.m. on Dec. 23, the Exchange is advising customers to select plans by 10 p.m. that evening and avoid the expected heavy online traffic. Customers who sign up after that time may be asked to take additional steps on the way to having their coverage confirmed.

On September 30, 2015, about 9.3 million consumers had effectuated Health Insurance Marketplace coverage – which means those individuals paid their premiums and had an active policy at the end of September. HHS’s effectuated enrollment projection continues to be 9.1 million people for the end of 2015.

I launched the "State by State" chart feature towards the end of the 2015 Open Enrollment period last time around, and it proved to be pretty popular, so I've brought it back this year.

It's important to note that I'm still missing data from some state exchanges; I have bupkis from DC, Idaho, Kentucky, New York and Vermont. I also only have partial data from others (California includes new enrollees only, while several other states only have data for the first couple of weeks).

With all those caveats out of the way, here's where things stand. Just like last year:

As I expected, the Week Seven numbers were a bit confusing due to a) the deadline surge; b) the 2-day extension of the deadline and especially c) the auto-renewal factor. While "the vast majority" of auto-renewals (2.28 million of them) were already added to the Week Seven total, CMS says that there are still "some" auto-renewals yet to be added. I wasn't expecting them to spill auto-renewals over into the following week, so things are kind of messy this week.

In addition, while these won't impact the federal exchange numbers, several state-based exchanges (Maryland, Massachusetts, Minnesota, New York, Rhode Island and Washington State) have/had January deadlines later than the 12/17 one on the federal exchange and some other states, so there's a lot of bumpy numbers going into Week Eight.

As I note every week, between Rhode Island's tiny population, tinier ACA exchange numbers and especially their decision to "front-load" autorenewals of all current enrollees ahead of the 12/23 deadline for January coverage, their official QHP selection tally is only going up a few hundred per week. Week Seven is no diffferent:

Update 12/18/15: Not really an update so much as a clarification: I'm guessing active QHP selections for this week via HC.gov could run anywhere between 1.0 - 2.0 million, plus another 2.5 - 3.5 million automatic renewals, for a weekly total of between 3.5 - 5.5 million.

You know you’re in trouble when more people purchased Beyoncé CD than signed up for Obamacare…

— MATT DRUDGE (@DRUDGE) December 29, 2013

Beyonce’s surprise album sold 991,000 copies in less than two weeks through Dec. 22, according to Billboard. The White House is trumpeting its 1.1 million sign-ups on healthcare.gov through Christmas Eve, of which 975,000 came in December.

Yes, because it's incredibly surprising that more people shelled out $13 to buy a new album from one of the most popular entertainers of the decade than happened to enroll in a private health insurance policy.

In equally shocking news, more people also ate at McDonalds and more tubes of toothpaste were sold that month as well.

The Connecticut ACA exchange, AccessHealthCT, hasn't given out any official OE3 enrollment updates since November 17th. At the time, their official number appeared to be absurdly high because, like Rhode Island and Massachusetts, CT decided to "front-load" their auto-renewals up front. This is purely a record-keeping/reporting thing, because any of those who have been auto-renewed could still cancel their renewals at any time before January, so it doesn't really impact what the final number ends up being.

Anyway, as of 11/17, Connecticut's official tally was 93,657 current enrollees renewing (either actively or automatically), plus another 5,470 new additions, for a total of 99,127.

Of course, not only does this number not include a solid month's worth of data, the final week of that missing period was last week's mid-December deadline surge. Unlike HC.gov and several other states, CT did not extend their 12/15 deadline for January coverage, although of course residents still have until 1/15 to sign up for February coverage, and until 1/31 to get covered starting in March.

After a bunch of Republican debates in which the ACA in particular and healthcare in general was barely touched upon, and only a minor mention or two of either during the first two Democratic debates, the ACA was finally front and center for one brief, glorious moment during last night's New Hampshire Democratic Primary Debate on ABC.

Unfortunately, when I was actually watching the debate, I got distracted by something and as a result, most of Hillary and Bernie's responses sounded quite solid. However, upon re-watching/reading the transcript, I'm actually kind of...disappointed by both of them, for different reasons (which is particularly stunning given that healthcare reform is such a major part of both of their platforms).

Yesterday they issued a mid-December update; the total number is now up to over 150,000:

The upcoming deadline coincides with the biggest surge in sign-ups seen during the current enrollment period. Since the start of the month more than 27,000 customers have selected plans for coverage starting Jan. 1, bringing the total number of those selecting coverage since the start of open enrollment to over 150,000.

The enrollment total is likely to increase in the coming days because administration officials are still working with about 1 million people who weren't able to get through to the call center or website near the deadline and left contact information with the exchange.

Six hundred thousand people actively enrolled in private healthcare policies on Tuesday, December 15, 2015 by using HealthCare.Gov.

Forget about the cumulative total for a moment. Forget about the auto-renewals still to be added. Forget about the state-based exchanges. Just focus on the fact that in a single 24-hour period, 600,000 people signed up through the federal exchange site only.

Now think back to October 2013, when HC.gov and 17 state-based exchange websites launched...and, for the most part, immediately crashed and burned.

BOISE, Idaho – Since Open Enrollment began on November 1, over 93,000 Idahoans have selected a health insurance plan for 2016 through Your Health Idaho. Approximately 86,000 Idahoans are currently enrolled for 2015 coverage.

“We are pleased to see an increase in enrollments at this half-way mark,” said Your Health Idaho executive director, Pat Kelly. “This demonstrates there is a continued need for access to affordable healthcare in Idaho. The good news is that Idahoans who remain uninsured still have until January 31 to enroll for health and dental coverage. But we encourage people to act now.” Idahoans who complete an application between now and January 31 will have coverage as early as February.

Idahoans who need assistance picking a health insurance plan can find a local agent or broker in their community to help them free of charge by visiting www.YourHealthIdaho.org and clicking on “find help near you.”

OK, this is a bit of a downer on an otherwise extremely positive day, but given my recent obsession with trying to track down the number of people still currently enrolled in effectuated policies for 2015, it seems worth making note of.

Back in early November, I cobbled together the effectuated enrollment data from 8 different state-based exchanges, and concluded that the numbers stayed relatively from the end of June through the end of September. With Massachusetts included, the numbers were actually higher, and even without MA included (special case) it was only down a nominal amount. With only 8 states representing a small percentage of the national population, however, there was no way of knowing how representative this was.

Just to clarify, I fully realize that Disney/LucasFilm would've had to agree to such an official ad campaign.
I'm assuming that it's OK for me to do this under parody/fair use.
Images will be removed if requested. Please don't sue.

DENVER (AP) – A new insurance-matching tool similar to Uber car sharing is helping Colorado’s health insurance exchange meet demand during the open enrollment period for people who need to sign up for health coverage , an exchange official said Thursday.

And an extended deadline didn’t hurt.

Open enrollment ends in January for Connect For Health Colorado. But Thursday was the deadline for shoppers to have coverage in effect by Jan. 1.

More than 117,000 people had signed up, though exact figures weren’t available, said Connect For Health spokesman Luke Clarke.

Connect for Health wants to see 217,000 people signed up by next summer. Clarke said the exchange is ahead of last year’s pace, when 113,000 had signed up by the December deadline.

The article doesn't specify what the "thru date" for the 117K figure is, but I'm assuming that it was as of 12/15 since that was the original deadline for January coverage and the story ran today.

In other words, like Massachusetts, Maryland has already hit the target for the 2016 Open Enrollment just halfway through the period. The difference is that Massachusetts never really issued their own formal target (well, OK, technically Maryland needs 235 more people...)

The Affordable Care Act’s third open enrollment period will end on Jan. 31, but the latest Kaiser Health Tracking Poll finds that only a small share of people without health insurance realize it.

Just 7 percent of the uninsured correctly identify January as the deadline to enroll; another 20 percent say the deadline is at the end of 2015, while everyone else either says they don’t know, gives another date or says the deadline has already passed.

More than 55,000 Sign Up Over Two Days As Covered California Extends Deadline for Consumers

SACRAMENTO, Calif. — Covered California announced Wednesday that more than 197,000 consumers had enrolled in health care coverage by the end of Tuesday, Dec. 15, including more than 22,000 on Monday and more than 32,000 on Tuesday.

The two-day total of more than 55,000 surpassed the enrollment figures seen last year during the same two day period when more than 35,000 people signed up for coverage on Dec. 14-15, 2014.

“The interest we have seen over the last two days is further proof of the continued demand that Californians have for quality, affordable health care coverage,” said Covered California Executive Director Peter V. Lee. “We want to make sure that everyone who is working to get in the door has the time they need to get the coverage they deserve.”

Given the crazy developments of the past day or so, combined with the auto-renewal factor, things are kind of fuzzy this week. I'm gonna hold tight and assume roughly 4.3 million QHPsincluding auto-renewals will be added to the mix by Saturday, bringing HC.gov up to a total of 8.5 million by Saturday, December 19th.

However, there's a major caveat here: I have no idea how many auto-renewals will be added, so I could easily be off by as much as a half a million or so this week.

Update 12/18/15: Not really an update so much as a clarification: I'm guessing active QHP selections for this week via HC.gov could run anywhere between 1.0 - 2.0 million, plus another 2.5 - 3.5 million automatic renewals, for a weekly total of between 3.5 - 5.5 million.

REMEMBER, as always, that this only includes the 38 states included on the federal exchange; when you throw in the other 13 running their own exchanges, the grand total (assuming I'm in the ballpark) should be roughly 11.3 million QHPs nationally by the end of the week.

I launched the "State by State" chart feature towards the end of the 2015 Open Enrollment period last time around, and it proved to be pretty popular, so I've brought it back this year.

It's important to note that I'm still missing data from some state exchanges; I have bupkis from DC, Idaho, Kentucky, New York and Vermont. I also only have partial data from others (California includes new enrollees only, while several other states only have data for the first couple of weeks).

In addition, there are three states (Connecticut, Rhode Island and Washington State) where I have the opposite situation--they've front-loaded their autorenewals of current enrollees, with the understanding that those folks can still drop their coverage or switch to a different policy between now and December 15th (CT) or December 23rd (RI & WA).

With all those caveats out of the way, here's where things stand. Just like last year:

I'm sticking to my guns for Week 6, projecting an even 1.5 million QHP selections via HealthCare.Gov, bringing the grand total to 4.34 million as of 12/12.

REMEMBER, as always, that this only includes the 38 states included on the federal exchange; when you throw in the other 13 running their own exchanges, the grand total by the 12th should be roughly 5.76 million QHPs nationally.

More than 1.3 million consumers signed-up for health coverage through the HealthCare.gov platform between December 6 and December 12, the last full week before the deadline for January 1 coverage, bringing the total number of plan selections made since Open Enrollment began on November 1 to 4.17 million consumers. Approximately 500,000 were new consumers, for a cumulative total of about 1.5 million new consumers since the beginning of Open Enrollment.

As I note every week, between Rhode Island's tiny population, tinier ACA exchange numbers and especially their decision to "front-load" autorenewals of all current enrollees ahead of the 12/23 deadline for January coverage, their official QHP selection tally is only going up a few hundred per week. Week Six is no diffferent:

Second, and more to the point, in light of last night's 2-day extension and corresponding server overload, I have no way of knowing a) what the "spread" of QHP selections is between new and active renewals, and b) I have no idea whether Wednesday/Thursday/Friday will be three huge days in a row or a single massive day followed by two "merely large" days.

BLITZER: But my question was: Should these Silicon Valley companies be forced to cooperate with the FBI?

FIORINA: They do not need to be forced. They need to be asked to bring the best and brightest, the most recent technology to the table. I was asked as a CEO. I complied happily. And they will as well. But they have not been asked.That's why it cost billions of dollars to build an Obama website that failed because the private sector wasn't asked.

Note to Carly Fiorina: The original HealthCare.Gov, which launched and, yes, failed miserably in 2013 was built by the "private sector"...namely, Canadian-owned CGI Federal.

This isn't particularly surprising now that HealthCare.Gov has already done the same thing, but it's still big news:

COVERED CALIFORNIA EXTENDS ENROLLMENT DEADLINE FOR JAN. 1 COVERAGE

Current enrollment surpasses last year’s demand

SACRAMENTO, Calif. — Due to very high demand for health insurance through Covered California, the deadline to enroll for coverage starting Jan. 1 will be extended until Dec. 17 to accommodate the surge in interest.

The Service Center will be open from 8 a.m. to 8 p.m. on Dec. 16 and Dec. 17.

“The spike in interest we are seeing in the last few days tells us there is continued demand for quality, affordable coverage,” said Executive Director Peter V. Lee. “We already have enrolled more consumers this year for Jan. 1 coverage than we did last year.”

Covered California has heard from our certified enrollers, including agents, that they still are processing thousands of applications and appreciate the additional time to ensure consumers receive coverage for all of 2016.

“We want to make sure everyone calling for coverage gets the help they need,” Lee said.

“Because of the unprecedented demand and volume of consumers contacting our call center or visiting HealthCare.gov, we are extending the deadline to sign-up for January 1 coverage until 11:59pm PST December 17.Hundreds of thousands have already selected plans over the last two days and approximately 1 million consumers have left their contact information to hold their place in line. Our goal is to provide access to affordable coverage, and the additional 48 hours will give consumers an opportunity to come back and complete their enrollment for January 1 coverage. ”

--Kevin Counihan, CEO of the Health Insurance Marketplaces

Welp, you can probably throw The Graph out the window now, at least in terms of the "spike" hitting right around now. My model was based on the assumption that yes, there'd be a huge spike yesterday and today, followed by perhaps 3 million auto-renewals being tacked on all at once tomorrow/Thursday.

Just a quick hit: There's now just under 7 hours to go before the December 15th deadline for January 1st coverage (I'm assuming the actual deadline is midnight Pacific time?), and it looks like we've indeed reached the server capacity limits of HealthCare.Gov; it placed me on the "Waiting Room" screen for a solid 10 minutes before redirecting me to the account login page.

The short version is that about 710,000 enrollees forgot to file a tax return at all (or didn't even know they were required to do so). Another 760,000 did file their taxes, but forgot to include the extra Form 8962 which was required to reconcile their 2014 tax credits (one of those happened to be, ahem...me).

OK, this is pretty nifty! You know those way-cool interactive color-coded maps that you see on major media sites like the NY Times? The ones where you can roll over each state and get pop-up data, etc?

Well, a company called Graphiq which specializes in exactly these maps has done just that with some of my data. The map below shows the percentage of those eligible to enroll in ACA exchange policies who were enrolled as of June 2015. Obviously these numbers have likely shifted since June, and will look quite different starting in January, but this is the most recent hard data available.

Not an official data update, but a nice catch from Louise Norris (the article is mainly about MNsure bumping out their enrollment deadline from 12/15 until 12/28):

As of Sunday, MNsure reported 26,532 sign-ups in private insurance policies through the exchange, including 18,595 new enrollees. The overall sign-up tally is up by more than 8,800 people in a five-day period, and the new enrollee figure is up by 6,415 people.

SACRAMENTO, Calif. — With just one day remaining to enroll for health insurance starting in January, Covered California announced that more than 140,000 consumers had enrolled in coverage by the end of Sunday, Dec. 13.

“Once again, Covered California is seeing an incredible surge of interest, and thousands of people are enrolling at storefronts, insurance agent offices and community centers across the state every day,” Covered California Executive Director Peter V. Lee said. “Everyone who needs health insurance, or knows someone who does, should know they can get financial help to pay for top-brand health insurance coverage, and if they enroll by Dec. 15, their coverage can start on Jan. 1.”

Although open enrollment runs through Jan. 31, 2016, consumers must enroll by midnight Dec. 15 to have their coverage start by New Year’s Day.

HOWEVER, assuming that both the Week Six total as well as the "spike" trend I projected turn out to be accurate, that means that these final days should be playing out something like the following:

Sunday, 12/13: Around 350K nationally (270K via HC.gov)

Monday, 12/14: Around 460K nationally (350K via HC.gov)

Tuesday, 12/15: Around 780K nationally (600K via HC.gov)

Yes, that's right, it's conceivable that HealthCare.Gov could see up to 600,000 people select private policies in a single 24-hour period tomorrow, plus up to another 180,000 via the various state exchanges.

A few weeks ago, I attempted to figure out at what point the cost of paying for healthcare policy premiums would start to outweigh the Shared Responsibility Mandate Penalty for not having ACA-compliant coverage for 2016. For my own experiment, I was looking purely at the "young invincible" target market: Single, childless individuals between 26-35 years old, earning between $20K - $40K. I ran "real world" checks across 10 major U.S. cities. My conclusion was that for this market in particular, signing up through the ACA exchanges was obviously the smart play up until they hit around $25,000/year in income. After that it started to become more of a judgment call depending on their circumstances and how much of a gamble with their health they're willing to take.

Beginning today, HealthCare.gov is piloting a new beta feature that allows consumers to search plans by their preferred provider or health facility. Some consumers will be part of a pilot that allows them to use the beta Doctor Lookup feature as they compare their coverage options in window shopping or when selecting a plan.

...For the first time, insurers are required to provide up-to-date information about which doctors and facilities are in their networks. Plans must also provide access to information on what medications are covered in the health plan formulary. In the coming weeks, HealthCare.gov expects to pilot the Prescription Drug Check feature, as well, which will allow consumers to search for whether a plan covers their prescription drugs.

If you take a look at the State-by-State chart, you'll notice that in addition to a few clarifications here and there, there are 5 states (well, 4 states +DC) all the way at the bottom labelled "NO DATA YET".

California insists, just like last year, on doing this weird thing where they release the number of new enrollees who have signed up on a fairly regular basis, but the number of renewals by current enrollees is kept a secret all the way into January. I have no idea why they do that, and it's pretty important given that we're likely talking about somewhere between 1.0 - 1.3 million people here.

On the other hand, at least they've posted data on their new additions. DC, Idaho, Kentucky, New York and Vermont haven't even done that much as of this writing.

Unlike the exchange QHP enrollments, which will always continue to be the heart and soul of this website (it's right there in the name, after all), I've kind of gotten away from trying to track Medicaid expansion on a granular level over the past few months. The main reason for this is that in many of the expansion states, they've simply maxed out on enrollees, and the numbers from week to week or even month to month are simply holding steady at this point.

In 2014, Massachusetts' ACA exchange website was one of the biggest disasters of the site rollouts, managing to enroll fewer than 32,000 people while flushing tens of millions of dollars down the drain. The biggest problem was that the system couldn't accurately determine whether enrollees were eligibile for federal tax credits or not...which was kind of important since around 85% of enrollees nationally qualify for them.

This was especially embarrassing given that not only is Massachusetts considered a major technology base (hey, it's right there in the name: Massachusetts Institute of Technology...), it was also, of course, the home of the precursor to the Affordable Care Act, aka "RomneyCare". You can read the entire ugly story in vivid detail thanks to Ed Lyon's amasingly detailed Health Connector Autopsy Report.

As anyone who's been following the ACA exchange saga over the past few years knows, the original idea was that all 50 states (+DC) would establish their own, individual healthcare exchange, including their own website/technology platform for enrolling residents in private policies (QHPs), Medicaid (supplementing or replacing whatever existing Medicaid system they already had) and small business policies (the ACA's SHOP program). In addition, each state exchange would also have their own board of directors, marketing department, support call center, fee structure for covering the cost of operations and so on.

If things had worked out that way, there would have been 51 different websites where people would enroll in ACA policies, each one independently branded.

(sigh) OK, this one is not related to the Risk Corridor Massacre, since Community Health Options was actually profitable in 2014 and therefore never qualified for any RC payments anyway. Also, unlike the dozen ACA-created co-ops which are in the process of winding down operations by the end of the year, CHO is not going out of business, and in fact is remaining fully operational for 2016.

Maine's Community Health Options said Dec. 9 that it will cut short its sales of individual policies for 2016, in a sign that it is the latest Affordable Care Act-funded consumer operated and oriented plan to encounter financial difficulties.

Here, again, is the original wording of the passage from Roy's article in question (Google's Cache tool seems to bring up a blank screen for the article for some reason, but I assure you, this was the original wording, verbatim):

Obamacare has reduced the uninsured rate by only 2%

In 2010, when Obamacare was passed, the Congressional Budget Office projected that the law would reduce the number of uninsured in 2014 by 19 million, relative to the number of people without health insurance in 2010. By 2016, CBO estimated that 30 million fewer people would be uninsured.

I'm sticking to my guns for Week 6, projecting an even 1.5 million QHP selections via HealthCare.Gov, bringing the grand total to 4.34 million as of 12/12.

REMEMBER, as always, that this only includes the 38 states included on the federal exchange; when you throw in the other 13 running their own exchanges, the grand total by the 12th should be roughly 5.76 million QHPs nationally.

I launched the "State by State" chart feature towards the end of the 2015 Open Enrollment period last time around, and it proved to be pretty popular, so I've brought it back this year.

It's important to note that I'm still missing data from some state exchanges; I have bupkis from DC, Idaho, Kentucky, New York and Vermont. I also only have partial data from others (California includes new enrollees only, while several other states only have data for the first couple of weeks).

In addition, there are three states (Connecticut, Rhode Island and Washington State) where I have the opposite situation--they've front-loaded their autorenewals of current enrollees, with the understanding that those folks can still drop their coverage or switch to a different policy between now and December 15th (CT) or December 23rd (RI & WA).

As I note every week, between Rhode Island's tiny population, tinier ACA exchange numbers and especially their decision to "front-load" autorenewals of all current enrollees ahead of the 12/23 deadline for January coverage, their official QHP selection tally is only going up a few hundred per week. Week Five is no diffferent:

INDIVIDUAL AND FAMILY ENROLLMENT As of December 5, 2015:

31,500 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.

Nearly all of these individuals are current HSRI enrollees that have been auto-renewed into a 2016 plan.

1,592 individuals have selected a plan for 2016 coverage, and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.

I have a doctor's appointment myself this afternoon which I have to leave for soon (irony!!), so the second half of my weekly analysis (state level) will have to wait until I get back, but here's the major story.

With the December 15th deadline just 1 week away and the December Surge starting to kick in, CMS decided to hold a full press conference call this morning ahead of the Week 5 HC.gov Snapshot report.

UPDATE 12/03/15: OK, strike that. This has been nagging at me all day. I'm bumping my HC.gov Week Five projection up further to 840,000 for 11/29 - 12/05 (2.88 million cumulatively), or around 3.77 million nationally.

The Washington Health Benefit Exchange today announced that more than 123,000 residents have selected Qualified Health Plans for 2016 coverage since the launch of the third open enrollment period on Nov. 1. Approximately 112,000 customers renewed plan selections from the previous year, with automatic renewals accounting for more than 84,000 of the 123,209 plans selected through December 1.

All residents who qualify must select a Qualified Health Plan throughwahealthplanfinder.org by December 23 to receive coverage by Jan. 1, 2016. Data collected from the first two open enrollment periods indicate a significant increase in sign-ups as the Dec. 23 deadline approaches. Open enrollment runs through Jan. 31, 2016.

As I noted a few weeks ago, Covered California has an annoying policy (they did this last year as well) of not publicizing how many current QHP enrollees have renewed their policies (or switched to a different exchange-based one) until well after the December deadline has passed.

As of Monday, Dec. 7, more than 83,000 Californians had selected plans through Covered California since open enrollment began on Nov. 1.

“Thousands of people are signing up every day for Covered California, and we’re off to a good start to meet our forecasted enrollment of 295,000 to 450,000 new enrollees during this third open-enrollment period,” Lee said.

OK, this one may seem a bit petty, but I'm recovering from a nasty flu at the moment (healthcare!!), so I'm in kind of a petty mood this morning.

Yesterday, Michael Cannon of the CATO Institute (aka the guy behind the infamous King v. Burwell case), who describes himself on Twitter as "Obamacare's Single Most Relentless Antagonist", tweeted out the following:

Out of all of the 2,500+ blog entries I've posted over the past 2+ years here, the one I'm most proud of was "A Response to Avik Roy", from March 25, 2014 (written right in the thick of the crazy, frenzied final week countdown of the first ACA Open Enrollment Period). This was when the site was at its highest traffic level and I was at my highest point of media attention. I was doing nothing but updating the site for about 16 hours per day, interrupted only by eating, sleeping and being interviewed by every outlet under the sun. Needless to say, I was frazzled, exhausted and short-tempered, and in fact I ended up falling victim to a nasty case of shingles as a result immediately after the close of the April 15th "Overtime Period" a couple of weeks later.

MICHIGAN WAIVER PUTS CMS IN TOUGH SPOT — The federal waiver Michigan needs to extend its Medicaid expansion has put CMS in a bind — either approve controversial conditions or let the program end next spring. Pro’s Rachana Pradhan writes, “The 2013 Michigan law expanding Medicaid included a provision requiring CMS to approve a waiver with drastically conservative changes by the end of this year. The waiver would require Medicaid enrollees earning above the poverty line to make a choice after four years of Medicaid coverage: Either enroll in a private subsidized plan on HealthCare.gov, or stay in Medicaid and pay up to 7 percent of household income toward health care costs — notably higher than the 5 percent ceiling CMS has held other states to.” If the waiver isn't approved, Medicaid expansion coverage is scheduled to end in April.

The Republican Chair of the House Ways & Means Committee, Newly minted Speaker of the House Paul Ryan (who was also Mitt "Grandfather of Obamacare" Romney's running mate just 2 1/23years ago, you might recall), has made it official:has made it official:

(Bloomberg) -- House Republicans won’t agree to fix Obamacare if the U.S. Supreme Court rules that the law bars health-insurance subsidies for millions of people, said House Ways and Means Committee Chairman Paul Ryan.

“There are a lot of other ideas out there, but what all conservatives can agree on is this: We think government should encourage personal responsibility, not replace it. We think prices are going up because people have too few choices, not because they have too many. And we think this problem is so urgent that, next year, we are going to unveil a plan to replace every word of Obamacare.”

A couple of weeks ago I posted an entry titled "UnitedHealthcare: Is loose SEP enforcement part of the problem?" in which I discussed the (supposedly widespread) problem of ACA exchange enrollees "gaming the system" by taking advantage of both the Special Enrollment Periods (aka "Off-Season Enrollments", as I prefer to call them) and/or the assorted grace periods allowed for under the ACA to deliberately sign up for private policies, quickly run up massive healthcare bills and then drop those policies soon afterwards, leading to massive actuarial disruption (ie, financial losses) for the carriers in their wake.

I gave a few examples of how this sort of thing might be happening, as well as my own suggestions for reducing such instances. Not being an expert on such issues, I limited myself to obvious, clear-cut ideas, mostly involving simple "date window" tightening, as well as tightening up of verification/enforcement:

I wasn't planning on posting anything else about yesterday's gun massacre in San Bernardino beyond my quick post last night, but I do have one more thing to add.

Yesterday (and today), a huge brouhaha broke out on Twitter about people (specifically right-wing politicians and pundits) once again offering nothing but "thoughts and prayers" as a response to the massacre.

This happens every time one of these horrors occurs; it's regular as clockwork. This time, though, many left-leaning folks got tired of the tired, boilerplate "thoughts and prayers" quips being given. Many on the right-wing side are now accusing left-leaners of "mocking" prayer, religion and/or God.

I've confirmed exactly 2,272,733 QHP selections nationally as of yesterday, but that only runs through last Saturday, while some states are missing entirely. My best guess as to the actual total as of 12/02/15 (32 days into the 2016 Open Enrollment Period) is around 3.14 million. That's an average of around 98,000 people per day signing up for private health insurance so far.

I've decided to start breaking out my official weekly projections for the upcoming week out separately from my analysis of the previous week; this way I'll have a "clean" entry to link to for all projections.

As I noted this afternoon, I came in 6.3% under for Week Four, making me exactly 1% under the actual cumulative total for the first 4 weeks:

Week 4 Projection: 370K / Actual: 395K

Cumulative Projection: 2.02 Million / 2.04 Million

Based on this, I'm once again bumping up my Week Five projection a bit, from 600K even to 670K for 11/29 - 12/05. If accurate, that will bring the grand HC.gov total up to 2.71 Million as of Saturday, December 5th. It should also bring the national total up to roughly 3.56 Million.

UPDATE 12/03/15: OK, strike that. This has been nagging at me all day. I'm bumping HC.gov Week Five projection up further to 840,000 for 11/29 - 12/05 (2.88 million cumulatively), or around 3.77 million nationally.

I launched the "State by State" chart feature towards the end of the 2015 Open Enrollment period last time around, and it proved to be pretty popular, so I've brought it back this year, starting today.

I couldn't start doing this earlier because this is the first week that CMS has broken out the HealthCare.Gov QHP numbers by state. Now that they've started doing so, I have cumulative numbers for enough states for a chart like this to make sense.

It's important to note that I'm still missing data from some state exchanges; I have bupkis from DC, Idaho, Kentucky, New York, Vermont and Washington. I also only have partial data from others (California includes new enrollees only, while several other states only have data for the first couple of weeks).

In addition, there are two states (Connecticut and Rhode Island) where I have the opposite situation--they've jumped the gun and front-loaded their autorenewals of current enrollees, with the understanding that those folks can still drop their coverage or switch to a different policy between now and December 15th (CT) or December 23rd (RI).

With two weeks to go before the Dec. 15 deadline for full 2016 health coverage, 31,740 people have enrolled in private health plans through Maryland Health Connection as of Dec. 1.

About 71 percent, or 22,477, were enrolled in silver plans, which provide savings in the form of advance premium tax credits and cost-sharing reductions for those eligible to lower their cost..

In total, 139,244Marylanders have enrolled in coverage through the state’s health insurance marketplace since open enrollment began on Nov. 1. That includes 107,504 enrolled in Medicaid, which accepts applicants year-round.

Also, 8,880 individuals have enrolled in dental plans which are available for the first time through MarylandHealthConnection.gov for 2016. Of those, 4,022 people enrolled in dental along with a qualified health plan (QHP), 2,756 enrolled in dental along with Medicaid and 2,102 enrolled in a stand-alone dental plan.

I still expect the current week to drop substantially due to it being Thanksgiving week. Note that last year the number dropped about 35% during Thanksgiving week before skyrocketing again the week after that; a similar drop this year would bring it down to around 330K for Week Four...although I'm gonna adjust my Week 4 projection upwards to 370K given the higher-than-expected results for Week Three.

As I note every week, between Rhode Island's tiny population, tinier ACA exchange numbers and especially their decision to "front-load" autorenewals of all current enrollees ahead of the 12/23 deadline for January coverage, their official QHP selection tally is only going up a few hundred per week. Week Four is no diffferent:

PROVIDENCE – HealthSource RI (HSRI) has released certain enrollment, demographic and volume data through Saturday, November 28, 2015, for Open Enrollment.

INDIVIDUAL AND FAMILY ENROLLMENT As of November 28, 2015:

31,238 individuals are enrolled in 2016 coverage through HSRI, paid and unpaid.

Nearly all of these individuals are current HSRI enrollees that have been autorenewed into a 2016 plan.

1,163 individuals have selected a plan for 2016 coverage, and are new to HSRI this year or returning after being enrolled with HSRI at some point during a prior year.

NOTE: The Weekly HealthCare.Gov Snapshot Reports are normally released at around 1:00pm on Wednesdays. I have a 1:00pm meeting today, so the odds are that I won't be able to write up a response/analysis of the weekly HC.gov numbers until late this afternoon.

Hospitals have cut down on deadly medical errors, saving around 87,000 lives since 2010, according to a new government report.

Pinning down the precise reasons for this change is difficult, to say nothing of predicting whether the decline will continue. Improvement has slowed in just the last year, the report suggests. But many analysts think government initiatives within the Affordable Care Act have played a significant role in the progress so far.

DENVER — Between Nov.1 and Nov. 29, more than 46,000 Coloradans enrolled in health coverage for 2016, either in private health insurance purchased through the state health insurance Marketplace or in Medicaid, or Child Health Plan Plus (CHP+), according to new data released today by Connect for Health Colorado® and the Colorado Department of Health Care Policy and Financing.

“The steady enrollment gains that we have seen during first month of Open Enrollment are very encouraging,” said Connect for Health Colorado® CEO Kevin Patterson. “But now we have just two short weeks to complete enrollment before December 15 – the deadline for coverage to take effect on January 1. I encourage anyone who has not signed up to do it today. Going to our website to find free, in-person help is a great way to start.”

Whether you are renewing or enrolling for the first time, you must complete enrollment by December 15, to have coverage January 1, and avoid a gap in your coverage. Open Enrollment runs through January 31.

ObamaCare is on life support and we have one senator who we can thank for planning years ahead a way to cripple the fraudulent program: Marco Rubio.

In 2013, Joshua Green, a liberal, recognized the role Marco Rubio played in his so-called “devious plan to kill Obamacare”:

Republican Senator Marco Rubio of Florida will introduce a bill today that represents a new and potentially crippling line of attack against the Affordable Care Act, aka Obamacare.

...Rubio’s bill takes a new tack by seeking to abolish “risk corridors,” one of several mechanisms in the law meant to hold down premium costs and entice insurers to participate in the exchanges by ensuring they won’t lose a lot of money if they draw a costlier applicant pool than anticipated. Risk corridors function like Major League Baseball profit-sharing: Insurers who wind up with unexpectedly healthy applicants and lower costs will “pay in” money to the government, which in turn “pays out” to insurers with costlier applicants, thereby stabilizing the nascent market. (snip)

...Once Republicans took over Congress Rubio’s bill passed into law. There would be no bailouts of health insurers. There would be no bailouts for health insurers. Rubio predicted the problems years before others (as he has with all the foreign policy crises) and figured out a way to deal with them. He laid out his plans in his op-ed in the Wall Street Journal years ago.

The number of people shopping for medical insurance on the Spanish-language version of HealthCare.gov is lagging behind last year's interest, even as the Obama administration urges Hispanics to sign up for coverage under the Affordable Care Act.

Federal figures released Wednesday show that about 153,000 people used cuidadodesalud.gov during the first three weeks of the current enrollment season for ACA health plans, down from 244,000 during the same period a year ago.